PD-L1 expression in gastric and gastroesophageal junction cancer patients treated with perioperative chemotherapy.

BACKGROUND AND OBJECTIVES: The incidence, predictive, and prognostic impact of programmed cell death (PD-L1) expression in gastric (GC) and gastroesophageal junction tumors (GEJC) treated with perioperative chemotherapy is poorly understood. We aimed to assess PD-L1 expression by immunohistochemistry (IHC) in both pre and posttreatment specimens evaluating its impact on pathological response and survival outcomes. METHODS: Retrospective cohort of patients with GC and GEJ tumors treated in a single western cancer center between 2007 and 2017. PD-L1 expression was assessed by IHC before and after neoadjuvant chemotherapy, in surgical samples, and reported as combined positive score (CPS). CPS > 1% was tested for its association with pathological response and overall survival (OS). RESULTS: We were able to assess PD-L1 expression in at least one tissue sample from 155 subjects. PD-L1 positivity rate was 20%. In 74 paired samples, a 21% discordance between PD-L1 expression in biopsy sample and surgical specimen was observed. With a median follow-up period of 60.3 months, 5-years disease-free survival was 60.5% with a median OS not reached. PD-L1 expression was neither associated with pathological response or survival outcomes. CONCLUSIONS: PD-L1 expression in the setting of locally advanced GC tumors was relatively low and can vary considering the tissue sample analyzed. This expression had no association with survival or pathological response in this population.

Epithelioid Rhabdomyosarcoma: Report of a Cutaneous Case and Literature Review of a Recently Described Variant of Rhabdomyosarcoma.

Rhabdomyosarcoma affects mainly pediatric patients and is currently classified into 4 categories: embryonal, alveolar, pleomorphic, and spindle cell/sclerosing. Epithelioid rhabdomyosarcoma is a recently described variant of rhabdomyosarcoma in which primary cutaneous presentation is infrequent. In this brief report, we describe a rare case of epithelioid rhabdomyosarcoma in an 81-year-old man, presenting as a skin lesion in the neck, which increased in size in 1 month. After imaging evaluation, a solid cervical mass was discovered. A biopsy was performed, and the diagnosis of epithelioid rhabdomyosarcoma was rendered. The patient died due to rapid progression of the tumor. To make an accurate diagnosis and ensure appropriate patient management, it is necessary to be aware of this variant and use proper immunohistochemical stains when facing an epithelioid malignancy, expanding the differential diagnosis of epithelioid neoplasms.

The prognostic influence of tumour budding in Western patients with stage II colorectal cancer.

BACKGROUND: Tumour budding (TB) refers to loss of tumour cohesiveness and is defined as isolated cells or a cell cluster of up to four tumour cells at the microscopic analysis. The International Tumour Budding Consensus Conference (ITBCC) in 2016 proposed a scoring system to standardise the pathology evaluation of TB in colorectal cancer (CRC) as high (H), intermediate (I) and low (L) TB. OBJECTIVE: To evaluate the recurrence-free survival (RFS) of stage II CRC patients as per the ITBCC 2016 classification and associations between TB and clinical pathological features. METHODS: Cases of stage II CRC undergoing surgery with available tumour tissue underwent central pathology review for TB. Prognostic factors, retrospectively retrieved from electronic medical charts, were evaluated in univariate and multivariate Cox regression analyses for RFS (primary end point). RESULTS: Among 137 patients included, L-TB was observed in 107 (78.1%), I-TB in 21 (15.3%) and H-TB in 9 (6.6%). In a median follow-up of 69 months, the median RFS was 134 months, with 14 patients (10.2%) presenting with tumour recurrence: 10 (9.3%) with L-TB, 2 (9.5%) with I-TB and 2 (22.2%) with H-TB. Perineural invasion was more commonly seen in the H-TB group. In multivariate analysis, TB (H and I versus L; HR = 2.6; p = 0.059) and not receiving adjuvant chemotherapy (HR 3.7; p = 0.020) were independently associated with RFS. Adjuvant chemotherapy was associated longer RFS (HR = 3.7; p = 0.022). CONCLUSION: In this series of Western patients, TB grade was associated with perineural invasion and increased risk of disease relapse.

Extramedullary Manifestation of Multiple Myeloma in the Oral Cavity.

BACKGROUND: Extramedullary plasmacytomas occurs in about 20% of multiple myeloma (MM) recurrences. Extramedullary disease seems to respond poorly to thalidomide and has adverse prognostic implication. When disease recurs in the oral cavity with soft tissue infiltration, some authors defend upfront surgical excision prior to radiotherapy with the aim of achieving better local control. We describe herein such an atypical case of recurrence from MM, with complete local response after 2 cycles of chemotherapy. Unfortunately, disease progressed later on, and the patient died after 9 months post-recurrence. This emphasizes the prognostic impact of extramedullary disease manifestation in MM.

Perfil bioético dos anteprojetos enviados ao comitê de ética em pesquisa daUniversidade do Estado do Pará / Perfil bioético de los proyectos enviados al Comité de Ética en Investigación dela Universidad del Estado de Pará / Profile of bioethics drafts sent to the ethics committee in research of Universidade do Estado do Pará

Este trabalho objetiva traçar o perfil bioético dos anteprojetos enviados ao comitê de ética em pesquisa (CEP) da Universidade do Estado do Pará (Uepa). Foram analisados todos os projetos enviados ao CEP entre janeiro de 2006 a dezembro de 2010, mediante aplicação de protocolo de pesquisa próprio, que permite analisar os quatro princípios da bioética principialista, bem como o sigilo. A análise dos anteprojetos do CEP/Uepa demonstrou que tendem a respeitar a beneficência e a autonomia do paciente, mas não contemplam na mesma medida a justiça e o sigilo, apontados no estudo como os princípios bioéticos menos respeitados; contudo, com o passar dos anos, houve melhora gradual dos princípios e do sigilo.

Este trabajo tiene como objetivo trazar el perfil de los anteproyectos enviados al Comité de Ética en Investigación (CEI) de la Universidad del Estado de Pará (Uepa). Se analizaron todos los proyectos presentados al CEI/Uepa entre enero de 2006 y diciembre de 2010, aplicando su propio protocolo de investigación, que permite analizar los cuatro principios de la Bioética Principialista y la confidencialidad. El análisis de los proyectos del CEI/Uepa demostró que tienden a respetar la autonomía y la beneficencia del paciente Dejando de contemplar en la misma medida la justicia y el sigilo, apuntados en el estudio cómo los principios bioéticos menosrespetados. Sin embargo, hubo una mejora gradual de los principios y del sigilo en los últimos años.

This paper aims at drawing the profile of drafts sent to Research Ethics Committee (REC) of the University of Para (Uepa). All drafts sent to REC between January 2006 and December 2010 were analyzed, by applying own research protocol allowing to analyze the four principles of the Principialis Bioethics, as well as secrecy. The analysis of REC/Uepa drafts showed that these tend to respect patient?s beneficence and autonomy, while justice and secrecy are the bioethical principles least observed, although an improvement trend has been seen with time.